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:

TACCN & FAST TNTP

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e-mail:

maxchien@mail2000.com.tw

:

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Head 6

Head 7

Vintracranial vault=Vbrain+Vblood +VCSF

http://images.google.com.hk/imgres?imgurl=http://www.geocities.com/drweightloss/neurosurgery/monrokellie.jpg&imgrefurl=http://www.geocities.com/drweightloss/neurosurgery/neurosurgery.html&h=478&w=650&sz=105&tbnid=ObTwXgbySvoJ:&tbnh=99&tbnw=135&start=2&prev=/images%3Fq%3Dmonro%2Bdoctrine%26hl%3Dzh-TW%26lr%3D%26sa%3DN

Head 8

50160 mmHg

PaO2PaCO2

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Head 10

GCS score

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(Glasgow coma scale)

G.C.S. 13-15 80%

G.C.S. 9-12 10%

G.C.S. 3-8 10%

15-24 y/o

77%

Head 12

1

2

3

4

5

6

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. . . . .

,

Head 14

EDH

SDH

ICH

Head 15

(CSF)

(CSF/hemotympanum)

1. (Air in sulci)

2. (Air and fluid/levels in

sinuses)

Head 16

(periorbital ecchymoses)

Battles sign (retroauricular)

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Skull Bone Fracture

http://www.business-presentations.co.uk/images/skulfrac.jpg

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Head 19

Head 20

concussion

(Diffuse Axon Injury)

(diffuse brain injury)

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Head 22

(Lucid interval)

0.5%()

CT

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Head 24

Head 25

SDH

30%()

5mm

Head 26

27

SDH

Head 28

Head 29

Head 30

31

Head 32

Contusion hemorrhage

Mottled

Speckled

Head 33

20-30%

1224

CT

Head 34

35

Pneumoencephalus ()

Head 36

37

Traumatic SAH & IVH

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Head 39

Head 40

Head 41

Glasgow Coma Scale

Head 42

GCS 14-15

3%CT

CT

CT

Head 43

Canadian CT Head Rules

1. High Risk (for neurological intervention) GCS < 15 at two hours after injury. Suspected open or depressed skull

fracture. Any sign of basal skull fracture. Vomiting 2 or more episodes. Age > 65. 2. Medium Risk (for brain injury on CT) Amnesia before impact > 30 minutes Dangerous Mechanism.

Head 44

Head CT Indications from

Other Studies 1. Drug or alcohol or

inappropriate mental status*

2. Physical findings of trauma above clavicle

3. Seizure

4. Coagulopathy.

5. Focal neurologic deficit

6. Graze wound from high velocity missile

7. Any vomiting*

8. Persistent deficit of short-term memory

9. Persistent anterograde amnesia

10. GCS 60 (by ACEP)

Head 45

GCS 9-13

10-20%

CT

12-24CT

Head 46

GCS 3-8

ABCDEs

CT(CT)

Head 47

Mannitol

- !

1g/Kgrepeat! (? CC )

Lasix

Anti-convulsants

Barbiturate

Head 48

(Ringers lactate or normal saline)

PaCO2 35 mmHg

Head 49

ICP

: 20 mmHg

: > 40 mmHg

Head 50

1. -

2.

3.

4.

5.

6.

Head 51

7.

8.

9. Cushing

10.

Head 52

1CT

2

3

1 mannitolglycerol

2dormicum atracurin

Head 53

1

2

PaCO2:30~35mmHg,

PaO2100mmHg

3Valsalva maneuvers

Head 54

436~37

5

30

6

Head 55

1.GCS

Head 56

5.

6.

7.

8.

9.

Head 57

Head 58

(SOP)

1ICU! 2 3on Foley, NG (or OG) 4 5!

6

Head 59

1/2

Head 60

2/2

(?)

30

/

Head 61

GCS =3

(oculocephalic, corneal, Dolls eyes and no gag reflex)

Head 62

Head 63

Head 64

Head 65

(I)

CT

Head 66

(II)

,

CPP> 70mmHg

(MAP 80 mmHg, SBP:140~160mmHg)

PaCO2 30mmHg

CT

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Head 68

Neck Collar

!

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Head 70

?

?

?

?

Head 71

?

?

Head 72

X-ray , CT , MRI

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Head 75

Head 76

Head 77

Head 78

,

(Bradycardia)

(Warm extremities)

atropine (?)

Vasopressors ( Dopamine ! )

Head 79

l- Halo-Vest

l8 Methylprednisolone 30mg/kg 24 5.4mg/kg/hr

l

l

Head 80

1.

2.

3.

4.

5.

6.

7.

Head 81

l

l

l

Head 82

l

l

l

l

Head 83

l

l

l

Head 84

l

l

l

Head 85

l

l

l

86

!! !!

Head 87

Question

?

TACCN & FAST TNTP

Head 88

Thanks!

TACCN & FAST TNTP